The effectiveness of unimodality organ preservation surgical vs organ preservation radiotherapy for early hypopharyngeal cancer: a systematic review protocol

Delu Gunasekera; Sahil Goel; Stephen Kao; Suren Krishnan; John Charles Hodge; Andrew Foreman; Jennifer Stone

doi:10.11124/JBIES-24-00120

The effectiveness of unimodality organ preservation surgical vs organ preservation radiotherapy for early hypopharyngeal cancer: a systematic review protocol

JBI Evid Synth. 2025 Jan 7. doi: 10.11124/JBIES-24-00120. Online ahead of print.

Authors

Delu Gunasekera^{1

2}, Sahil Goel^{1

2}, Stephen Kao², Suren Krishnan^{1

3}, John Charles Hodge^{1

3}, Andrew Foreman^{1

3}, Jennifer Stone²

Affiliations

¹ School of Public Health, The University of Adelaide, Adelaide, SA, Australia.
² JBI, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia.
³ Department of Otorhinolaryngology Head and Neck Surgery, Royal Adelaide Hospital, Adelaide, South, Australia.

PMID: 39763404
DOI: 10.11124/JBIES-24-00120

Abstract

Objective: Our aim is to determine the comparative effectiveness of unimodality organ preservation surgery versus radiotherapy on oncological and functional outcomes in patients with early hypopharyngeal cancer.

Introduction: Early hypopharyngeal cancer is difficult to detect and therefore rarely diagnosed, as patients are often asymptomatic. Radiotherapy is considered the main treatment, although this modality has been compared to the previously used open surgical approach, which may not reflect current surgical options. This is reflected in the available literature, with a paucity of data on management guidelines. Minimally invasive surgery is providing better access to the hypopharynx, such as CO2 laser microsurgery and transoral robotic surgery. These novel surgical procedures may pave the way for revised guidelines to managing hypopharyngeal cancer.

Inclusion criteria: We will include randomized controlled trials and quasi- (or pseudo-randomized) experimental studies that investigate organ preservation surgery and radiotherapy treatments for early hypopharyngeal cancer in adults with primary disease. Primary outcomes include disease-free survival of 2 years or up to 5-year overall survival. Secondary outcomes are functional, including swallowing, phonation, and complications associated with treatment, such as post-procedural hemorrhage; return to theater or return to operating room; tracheostomizing patients; post-radiation mucositis; dysphagia/odynophagia; and xerostomia.

Methods: The review will follow the JBI methodology for systematic reviews of effectiveness. Four databases will be searched, namely, PubMed, Embase (Ovid), CINAHL (EBSCOhost), and the Cochrane Library. Two independent reviewers will screen studies and assess methodological quality using the JBI critical appraisal tools. Individual study estimates will be pooled in a meta-analysis and presented in forest plots.

Systematic review registration number: PROSPERO CRD42023400206.